Anticonvulsants associated with suicidality

Although the overall risk is small, healthcare professionals should closely monitor all patients currently taking or
starting any anticonvulsant drug for notable changes in behaviour that could indicate the emergence or worsening of suicidal
thoughts or behaviour or depression.

In January 2008, the FDA issued an alert regarding suicidality (suicidal behaviour or ideation) in patients taking anticonvulsant
drugs. This came after analysing reports of suicidality from placebo-controlled clinical studies of eleven drugs used
to treat epilepsy, psychiatric disorders and other conditions. The analysis found that patients taking these drugs had
approximately twice the risk of suicidal thoughts and behaviours (0.43%) compared to those taking placebo (0.22%). The
increased risk of suicidal behaviour and suicidal ideation was observed as early as one week after starting an anticonvulsant
and continued throughout the following 24 weeks.

Anticonvulsants included in the analyses:

Carbamazepine

Felbamate*

Gabapentin

Lamotrigine

Levetiracetam

Oxcarbazepine

Pregabalin

Tiagabine*

Topiramate

Valproate

Zonisamide*

*Not available in New Zealand

Patients who were treated for epilepsy, psychiatric disorders and other conditions were all at increased risk of suicidality.
However, the relative risk was higher in the patients with epilepsy compared to patients who received one of the drugs
for psychiatric or other conditions.

The FDA reports that it is likely that all anticonvulsants pose an increased risk for suicidality and provide the following
advice for healthcare professionals:

Be aware of the possibility of the emergence or worsening of depression, suicidality, or any unusual changes in behaviour.

Inform patients, their families and caregivers of the potential for an increase in the risk of suicidality so they
are aware and able to notify their healthcare provider of any unusual behavioural changes.

PHARMAC announces subsidy changes for salbutamol inhalers

From the 1st June 2008, PHARMAC will be fully subsidising a new brand of salbutamol inhaler - Respigen (100 microgram
per dose). Subsidies for the existing brands, Salamol and Ventolin, have been reduced to the same level as Respigen. The
supplier of Salamol has reduced the price of the Salamol inhaler but Ventolin remains the same. This means that Salamol
and Respigen inhalers are fully subsidised, with a higher part charge on Ventolin. The three brands of inhalers are therapeutically
equivalent but differ slightly in appearance, taste and spray pressure.

For further information and resources on this change, contact PHARMAC by calling 0800 11 22 37 or emailing
resources@pharmac.govt.nz

The "cool" asthma device may improve adherence

New Zealand company Nexus6 Ltd has invented "Smartinhaler", a new asthma device aimed at young chronic asthma sufferers.
The device fits Ventolin, Serevent and Flixotide canisters and uses digital ring tones to alert children to take their
preventer. It also tracks medication use through the software contained within the device.

A study of 110 adults and adolescents with asthma found that use of the Smartinhaler over 12 weeks resulted in 93% of
fluticasone being taken as prescribed (250 mcg twice daily), compared to 74% in the control group who were not using the
reminder function of the device. Researchers concluded that an audiovisual reminder function can significantly improve
aherence to inhaled corticosteroid use in asthma.1

There is anecdotal evidence that use of the Smartinhaler has led to better asthma control in children. Parents report
that their children's asthma has improved markedly since beginning to use the device and often they end up using less
rescue medication.

The development of the Smartinhaler was partly funded by Cure Kids, a charity which raises money to fund medical research
into children's illnesses.

Smartinhaler is not funded. Smartinhaler products, information and online asthma management tools are available at:
www.smartinhaler.com